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Inspection on 23/02/09 for Nightingale Nursing Home

Also see our care home review for Nightingale Nursing Home for more information

This inspection was carried out on 23rd February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People told us they like living at the home as it is a relaxed and homely atmosphere. They say the staff are always friendly and attentive. There are plenty of things for people to do to keep them occupied. People feel they are listened to and some changes have been made as a result. People are helped to stay in good health.

What has improved since the last inspection?

The home has increased the variety of information available to people who are interested in living there. Staff training has increased and includes specialist areas so people can be better supported. There is an increased use of community facilities to help with activities. They have improved one of the bathrooms by making a wheelchair access shower room. They have attended to the requirements and recommendations of the last inspection.

What the care home could do better:

There were no requirements or recommendations identified at this visit. The home acknowledges however that, with an increasing percentage of service users with dementia they need to ensure that staff receive regular training input and updates and appropriate, interesting activities are put in place.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nightingale Nursing Home 43 Beach Road Littlehampton West Sussex BN17 5JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Geoffrey Senior     Date: 2 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Nightingale Nursing Home 43 Beach Road Littlehampton West Sussex BN17 5JG 01903717376 01903732933 nightingale.caring@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cadogan Care Limited care home 35 Number of places (if applicable): Under 65 Over 65 0 35 dementia old age, not falling within any other category Additional conditions: 35 0 The maximum number of service users to be accommodated is 35. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Nightingale Nursing Home is a detached three storey Edwardian house located in the town of Littlehampton. The house overlooks a park and is a few minutes walk from the shops, public transport, local amenities and the sea front. The accommodation is provided on two floors with a lift providing access between the ground and first floor. There are 31 single rooms with three rooms offering en-suite facilities and two rooms offering shared facilities. One single room is accessible via a short flight of stairs. A lounge with dining space is available on each floor. There is a small outdoor space available with seating for the residents. Fees range between £575 and £675. The Home provides care and accomodation, with Care Homes for Older People Page 4 of 25 Brief description of the care home nursing, for up to 35 service users with Dementia, who may be under 65 yrs on admission, and for Older People, 65 years and older who do not fall within any other category. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit to Nightingale was an unannounced Key Inspection. We arrived at the home about 1:30pm and stayed for about four hours. We sat with the Manager in her office for a while; talking about how the service is doing and looking at some of the records and documents. We also spoke with homes administrator as she had ready access to some of the records we need to see. We spent some time walking round the home and looking at the accommodation with the Manager. We met and spoke with a number of the service users and some visiting relatives. We also met and spoke with members of staff, some in private and observed them as they went about their work. In addition to the information collected on the day we also looked at the Annual Quality Assurance Assessment, (AQAA) and information we have received about the service Care Homes for Older People Page 6 of 25 since the last inspection. The last inspection of this home was conducted on 30.11.06. The Home provides care and accomodation, with nursing, for a maximum of 35 service users. Service users with Dementia may be under 65 years on admission. The home also accomodates Older People who do not fall within any other category. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are interested in living at the home are invited to visit and are given information to help them make a decision. They are asked what support they need and how they would like this to be done. Evidence: People who are interested in living at the home are invited to visit so they can meet and spend time with the people who already live there and the staff. They can look at the bedrooms and lounges and find out about the lifestyle and routine they could expect to experience at Nightingale.This is not always practicable and we were told that it is often a persons relatives or representative who comes the make the arrangements. The home is aware of the need for reassurance, support and information to help make a decision where to live. Every one is offered a service user guide and a statement of terms and conditions.Written information is available and we were told that plans are Care Homes for Older People Page 10 of 25 Evidence: underway to improve the presentation with pictures so people can see what the home looks like and have more description of the facilities and services they offer. Before people move into the home information is gathered from hospital staff, care managers and relatives and the person themselves. All the information is brought together to decide whether or not the home will be able to meet the service users needs and support them in the way they want. This then forms the basis for developing the care support plan. There is a mix of youth and experience in the staff team who have the skills and experience to meet the needs of the service users in their care. Staff were seen sitting and talking with the service users and the atmosphere was relaxed. The service users spoken with were happy and content with the home and felt that their needs were being met.One said that she felt really welcomed to the home and how kind the staff are. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be involved in their care and support planning. Their healthcare needs are being met and they are treated with kindness and respect. Evidence: People who live at Nightingale say the staff offer them all the assistance they need. Each person has an individual plan of care and personal support. These give people the opportunity to have a say in what support they want and how they want it done. Information is also sought from other sources if the service user is able to make only a limited contribution. The plans give information to staff so they know what to do when assisting service users. Staff said the plans were clear and understandable and help them to know what needs to be done, how, when and why. Staff make daily notes on each of the service users and report any changes so that plans are up to date and accurate. the manager and keyworkers review the plans each month.They check with the person concerned and with their relatives and the care support workers how things are going and what might need to be changed. The manager told us about introducing a memory box where service users can store Care Homes for Older People Page 12 of 25 Evidence: or have written down,things about their personal history or special memories so staff have a better understanding of what is important to them. Steps are taken to try to ensure that people do not have any avoidable accidents. These are recorded in the care plans as risk assessments. Some people may, for example, be unsteady on their feet so they will be accompanied by staff or have special rails fitted if they worry about rolling out of bed. Risk assessments are also completed for the risk of pressure damage and malnutrition. People are helped to stay well. Staff keep an eye out for signs of illness or change of condition so that the Doctor can be contacted without delay. Any visits to or from the local GP, physiotherapist, Community Nurse or other healthcare professionals are written down and the care plan updated as necessary. The home has procedures in place for dealing with medicines. Service users can manage their own when it is safe to do so. We looked at the records and storage for medications and found them generally satisfactory. Ther was a space on one of the Medication Administration Record sheets that had not been signed. Other sheets were checked and showed that this was not a regular occurence. The Manager said she would check with the person on duty at that tme and rectify immediately. People said that staff are always friendly and attentive.They are respectful of peoples privacy and we saw them knocking on doors before entering rooms. There was a relaxed atmosphere in tthe home with people being quietly and discreetly assisted. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are interesting things for people to do if they choose. People may to receive visitors and spend the day as they wish. Service users are offered a variety of good quality meals. Evidence: People said that there was a social gathering or event that they can join in with on most days. The home has an activities person who may instigate a group activity or take one or two individuals at a time out to the nearby town centre for shops or coffee. She is trying to increase the number of things that people with Dementia or are confused are able to do and enjoy. The home is keen to help people hold on to their independence and keep in contact with the local community. An electric outdoor chair is provided, with instruction and help so people can get to places on their own. Some of the service users attend the drop in centre nearby or go to the library. They do have a choice however and no one is jollied into doing things they do not want. Staff are aware of peoples interests and background history through the care plans as well as talking to them on a daily basis. Relatives and friends are invited to become involved in what is going on and join them occasionally for a meal. People are helped to keep in touch with their family and friends if this is what they want. People are welcome to call Care Homes for Older People Page 14 of 25 Evidence: at the home at any reasonable time. Staff keep in touch with them to keep them up to date and inform them of any significant changes or events. We were told that although there were no particular matters arising at the moment, any social, cultural or religious issues would be given every consideration and appropriately supported. The home welcomes visiting clergy and makes provision for religious services. We asked about the menus and food people are offered to eat. Service users said that they have really nice meals and there is always enough to eat. They are informed about what is on offer for each meal and can, if they wish, have an alternative. We were told that there is a good balance of meals with fish, meat and vegetables always available. People can choose where they take their meals but are encouraged to gather in the dining room as a social event. Snacks and drinks are available throughout the day and night so people do not have to go too long without refreshment. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure. There are arrangements to make sure complaints are dealt with properly. Evidence: People said that they feel safe living at Nightingale. They knew who to go to and would be quite happy to talk to them about any concerns, complaints or if anything was worrying them. There is information about making a complaint in the homes brochure but they would probably go straight to staff or relatives. The home keeps a complaints and action book which details any issue raised, the action taken and the outcome. Staff have received training in the protection of vulnerable adults and have guidelines available for further reference.The staff spoken to were clear about their responsibilities in keeping people safe and were aware of the process for reporting any concerns they may have. The home aims to protect residents when recruiting new staff by undertaking thorough background checks and references before they are allowed to start work. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nightingale provides a clean and homely environment for all who live, work and visit there. Evidence: Nightingale is a large detached house. The living areas and bedrooms are spread over two floors. These are accessible by stair or passenger lift. Not all bedrooms are for single occupation but, as the home is not full,every one currently has their own room. The people we spoke with like their rooms and those we saw were well decorated and homely with lots of personal possessions and ornaments on display. Everyone has a call alarm in their room to attract staff attention if they need help or assistance. Since the last inspection one of the bathrooms has been made into a walk in wheelchair accessible shower room. One of the bathrooms is still out of use but has been made inaccessible to service users and the radiator turned off. Other matters raised in the last inspection have reportedly been attended to. This includes attention to flooring repairs, provision of a new dishwasher,new hoists,an improvement in cleaning standards abnd waste recycling arrangements. Everywhere we saw appeared to be tidy and smelt fresh and clean. There is an ongoing programme of redecoration and repair so some areas still showed some signs of wear and tear but not neglect. The garden has been safely enclosed and although limited in size is accessible and has Care Homes for Older People Page 17 of 25 Evidence: areas to sit. A bird table has been provided for one service user in particular to watch from the windows but it may be enjoyed by all. Information sent to us by the home before the visit told us that the maintenance of equipment is up to date and satisfactory.There are measures in place for the control of infection and the safe handling of substances hazardous to health. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are well trained staff in sufficient numbers to care for and support the service users at all times. Evidence: We were told that there are always three care support workers and a qualified nurse on duty between 8am and 8 pm. One nurse and two carers work through the night. In addition there is a team of workers who deal with the cleaning and laundry and cooks to prepare and serve all three meals of the day. People said that staff have time for them and they do not get the feeling that they are being hurried. Someone always comes quickly if assistance is needed. Before people are employed as staff at the home the Registered provider completes a number of checks. This is to confirm their identity, take references and do a police check. They also check any qualifications people may have and ensure that Nurses working in the home are registered with the appropriate body.. We looked at the records of two staff and saw that these had been done. We were told that there is a low staff turnover and the home does not need to use agency staff so everyone on duty is familiar to the residents. New staff are offered introductory training before they work on their own and are then encouraged to use the training opportunities that are offered. We were told that more than half the staff have NVQ at level 2 or above. NVQ training aims to help staff Care Homes for Older People Page 19 of 25 Evidence: deliver good quality residential care services. There is a qualified nurse available on each shift team. Staff told us that they can do additional specialised training as the need arises. The most recent helps them to understand the support needs of people with Parkinsons. They discuss their development as workers and any training they might need during regular supervision sessions with the manager. Staff told us that they are able to attend additional training on specialised subject and discuss their development and training needs during regular supervision sessions. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is reliably managed. People are listened to when asked what they think about the home and the service it offers and improvements made as a result. Peoples health and safety is promoted. Evidence: The manager Ms Searle is a qualified nurse and has the Register Managers Award. She organises her time so that she can spend time supporting service users and staff members in their daily activities. People told us that there is an open and friendly atmosphere in the home, the manager is approachable and supportive. Staff said that there is a good team spirit and the handovers at the beginning and end of each shift means that every one knows what is going on and the support the service users get is informed and consistent . Staff have supervision with the manager at least six time a year. This means they have a chance to discuss their performance as workers and arrange any training that would improve their knowledge and skills. Service users, Care Homes for Older People Page 21 of 25 Evidence: relatives and staff are asked for their opinions about how the home is run and any ideas for improvement or change. People are asked to complete questionnaires and survey forms and changes have been made as a result. For example, changes to the menu, the purchase of reclining chairs, more outings and activities and easier to use taps fitted on some sinks. Formal meetings are also held for people to have their say. It is the managers intention to involve the service users more in the setting up of a pre admission booklet and the recruitment of staff. The Registered Provider is a frequent visitor to the home to see that her standards and expectations are maintained as well as making formal unannounced inspection visits each month and preparing a report on the conduct of the home. Staff have received training for the health and safety of people living and working in the home. The management undertake regular health, safety and maintenance checks to safeguard the well being of residents, staff and visitors. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!